Total levator aponeurosis resection for ptosis with poor levator function

Abstract

According to the age of onset of ptosis, it can be classified as congenital or acquired. Levator muscle function is the most important parameter for deciding on a surgical procedure. Usually, if the activity of the levator muscle is good or moderate, resection of the levator muscle is performed. However, if the activity of the levator muscle is weak (4 and less than 4 mm), the sling method will be the choice. However, the Sling method leaves many complications that are unfavorable in terms of function and aesthetics. Therefore, in this study, we investigated the effect of resection of the upper eyelid levator muscle in cases where muscle function was poor. Materials and Methods: Patients with ptosis referred to Tabriz Charity Hospital during 2011-2021 were included in the study using defined inclusion and exclusion criteria. Before and after surgery, routine ocular examination of all patients, including assessment of upper eyelid skin positions, measurement of levator ani muscle function (LF), LC and PFH, and margin-reflex distance (MRD), was recorded. Patients underwent levator ani resection of 20-25 mm (supramaximal). All patients were followed up for at least 6 months and the data collection form was completed based on the variables and objectives studied. Data were entered into SPSS software after classification and appropriate statistical analysis was performed. P <0.05 was considered significant in all tests. Results: The initial levator muscle function in the studied patients was 3.34 ± 0.60 mm, which improved after surgery and reached 6.25 ± 1.63 mm, which is an improvement in levator muscle function. It was statistically significant (P <0.001). The height of the eyelid cleft before surgery in the studied patients was 4.34 ± 1.18 mm, which in the postoperative evaluation reached 7.97 ± 1.18 mm, which also had a statistically significant improvement (P<0.001). The mean follow-up period in these patients was 66.38 ± 16.61 days. Surgical complications were observed in 9.4% of patients (n = 3), including conjunctival prolapse in two cases, SPK in two cases, in one of which conjunctival prolapse was associated with SPK.